ACE-LoRA: Graph-Attentive Context Enhancement for Parameter-Efficient Adaptation of Medical Vision-Language Models

Computer-aided medical image analysis is crucial for disease diagnosis and treatment planning. While vision-language models (VLMs) such as CLIP exhibit strong generalization ability, their direct application to medical imaging remains hindered by a substantial domain gap. Existing methods for bridging this gap, including prompt learning and unidirectional modality interaction, typically introduce domain knowledge into only one modality. However, such approaches fail to fully exploit CLIP's inherent dual-modality structure and overlook the synergistic effect of bidirectional cross-modal interaction, resulting in persistent modality misalignment. In this paper, we propose NEARL (iNteracted quEry Adaptation with oRthogonaL Regularization), a novel parameter-efficient VLM framework for bidirectional cross-modal interaction. NEARL consists of two key components: (1) the Unified Synergy Embedding Transformer (USEformer), which dynamically generates compact cross-modal queries to facilitate interaction; and (2) the Orthogonal Cross-Attention Adapter (OCA), which decouples new knowledge into truly novel and incremental components through orthogonal regularization. This design reduces interference from incremental components, enabling more focused learning of novel information and improving modality interaction in VLMs. Notably, NEARL introduces only 1.46M learnable parameters. Extensive experiments on three medical imaging modalities demonstrate state-of-the-art performance (e.g., a 2.3% relative improvement on the pneumonia dataset), along with fast inference and low memory overhead, highlighting its effectiveness for real-world medical vision-language understanding.

Medical Vision-Language Models (VLMs) exhibit strong zero-shot performance, yet their effectiveness still declines on out-of-distribution (OOD) data due to domain shifts and class bias inherited from large-scale pretraining. Existing few-shot adaptation methods typically introduce additional trainable components, which can be unstable in extremely low-data regimes (e.g., 1-shot), and lack robustness on different medical data. We present TCLA, a purely training-free few-shot adaptation method for Medical VLMs, which is fast and model-agnostic. TCLA corrects inference logits based on a small set of support samples, boosting pretrained VLMs performance by improving inter-class deconfusion and reducing domain shift. Extensive experiments on nine datasets across multiple medical imaging modalities including X-ray, Ultrasound, MRI, CT, Histopathology, demonstrate that TCLA consistently improves OOD performance of Medical VLMs and, in most of cases, outperforms existing training-based adaptation methods.

Medical vision-language models (VLMs) allow a single model to perform clinical image analysis tasks ranging from diagnosis classification to report generation. However, joint adaptation is challenged by heterogeneous output formats, conflicting task gradients, and imbalanced training data. Hence, we present Two-Stage Mixture-of-LoRA, a framework built on MedGemma-1.5-4B. The framework uses a shared-specific Mixture-of-LoRA architecture comprising one shared LoRA and six task-specific expert LoRAs, together with a two-stage training procedure. In Stage 1, we jointly train the shared LoRA and all task-specific expert LoRAs on all tasks. In Stage 2, we first freeze the backbone, the shared LoRA, and all non-target experts, and refine one task expert at a time. Classification and regression then receive an additional modality-balanced continuation, in which smaller modality groups are repeated to match the largest group. In the FLARE 2026 Task 3 test sets, the proposed method achieves 0.85 balanced accuracy for classification, 0.48 micro-F1 for multi-label classification, 0.79 detection F1, and 17.39 regression MAE. Code is available at https://github.com/YuanYL03/MICCAI-FLARE-2026-Challenge-Task3-2D.